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Case Reports
. 2023 Dec 4:14:1243208.
doi: 10.3389/fimmu.2023.1243208. eCollection 2023.

Case Report: Long-term metabolic response of metastatic uveal melanoma to pembrolizumab on FDG-PET/CT despite a serial pseudoprogressions phenomenon

Karim Amrane #  1   2 , Coline Le Meur #  3 , Philippe Thuillier  2   4 , Jacques Dzuko Kamga  5 , Pierre Alemany  6 , Frederic Chauvelot  7 , Clémence Niel  1 , Alex Bellange  1 , Ronan Abgral #  5   8
Affiliations
Case Reports

Case Report: Long-term metabolic response of metastatic uveal melanoma to pembrolizumab on FDG-PET/CT despite a serial pseudoprogressions phenomenon

Karim Amrane et al. Front Immunol. .

Abstract

Uveal melanoma (UV) is a rare and aggressive melanoma with poor 1-year survival. up to 50% of UV patients develop metastases, mainly to the liver. Here, the authors present a 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography (18F-FDG-PET) study of a very rare case of secondarily metastatic UV in an 81-year-old Caucasian with a dramatic response to pembrolizumab associated with serial pseudogression. 18F-FDG-PET associated with clinical status and peripheral blood derived neutrophil-to-lymphocyte ratio (dNLR) were performed to guide therapeutic strategy due to an atypical pseudoprogression phenomenon.

Keywords: FDG-PET; immune checkpoint inhibition; pembrolizumab; pseudoprogression; uveal melanoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
FDG-PET first pseudoprogression : (A, D: MIP and Axial baseline), (B, E : MIP and Axial unconfirmed progressive metabolic disease (uPMD) with 28% increase in SULpeak of the main lesion, (C, F: MIP and Axial confirming a pseudoprogression (PsPD).
Figure 2
Figure 2
FDG-PET second pseudoprogression : (A, D: MIP and Axial disease stable before progression), (B, E : MIP and Axial disease progression according to PERCIST criteria with 28% increase in SULpeak of the main lesion and the appearance of 2 new lesions), (C, F: MIP and Axial confirming a pseudoprogression (PsPD) with 15% decrease in SULpeak with the disappearance of the 2 new hypermetabolisms corresponding to a uPMD according to iPERCIST criteria.
Figure 3
Figure 3
FDG-PET MIP third pseudoprogression (A, D: MIP and Axial disease stable before progression), (B, E : MIP and Axial disease progression according to PERCIST criteria with 27% increase in SULpeak of the main lesion and the recurrence of the 2 previous lesions), (C, F: MIP and Axial confirming a pseudoprogression (PsPD) with a stable SULpeak with renewed disappearance of the 2 hypermetabolisms seen on the previous scan.
Figure 4
Figure 4
FDG-PET therapeutic response assessment with biological parameters.
See this image and copyright information in PMC

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